Ortho Flashcards
1
Q
osteoarthritis
A
progressive, irreversible condition involving loss of articular cartilage
2
Q
associations of osteoarthritis
A
age
obesity
trauma
3
Q
Heberden’s nodes
A
at DIP
4
Q
Bouchard’s nodes
A
at PIP
5
Q
x-rays of osteoarthritis
A
loss of joint space
slcerosis
subchondral cysts
osteophytes
6
Q
symptoms of osteoarthritis
A
stiffness, pain, deformity
worse at end of day, in groin for hip OA
7
Q
treatment of osteoarthritis
A
weight loss PT bracing glucosamine/chondroitin NSAIDs cymbalta steroid injection viscosupplementation-gel for lubrication to increase protein arthroscopic debridement joint replacement
8
Q
rheumatoid arthritis
A
autoimmune disorder with inflammatory synovitis that destroys cartilage
symmetrical distribution of joints
9
Q
requirements for RA
A
morning stiffness arthritis of 3 joints for 6 weeks systemic arthritis for 6 weeks rheumatoid nodules \+RF factor radiographic changes
10
Q
clinical findings for RA
A
joint contractures, effusions, deformity
ulnar deviation of hands
PIP and MCP inflammation
elevated ESR and CRP
11
Q
rheumatoid factor
A
IgM antibodies against Fc portion of IgG
12
Q
RA HLA
A
DR4
13
Q
treatment RA
A
NSAIDs
steroids
DMARDs-hydroxychloroquine, methotrexate, gold, Embrel
surgery
14
Q
septic arthritis
A
infection in the joint
most common in kids from hematogenous spread
15
Q
cause of permanent damage in septic arthritis
A
metalloproteases
16
Q
symptoms of septic arthritis
A
fever, tachycardia
pain with ROM
17
Q
clinical findings for septic arthritis
A
slight flex in joint passive ROM is painful elevated or normal WBC joint aspirate >50k WBC elevated ESR, CRP
18
Q
septic arthritis in neonate
A
staph aureus
GBS
19
Q
<5yo septic arthritis
A
staph aureus
GAS
h flu
strep pneumo
20
Q
septic arthritis in adolescents
A
gonorrheoeae
21
Q
septic arthritis in adults
A
staph aureus
22
Q
septic arthritis in sickle cell patients
A
salmonella
23
Q
chronic septic arthritis
A
TB or lyme
24
Q
treatment of septic arthritis
A
surgical washout
antibiotics immediately
25
ankylosing spondylitis
uveitis, carditis, enthesitis (inflammation of attachment of tendons)
26
HLA in ankylosing spondylitis
HLA-B27
27
Reiter disease
after urethritis, cervicitis, dysentery
| reactive arthritis 2-8 weeks after infection
28
psoriatic arthritis
nail disorders
| iritis
29
IBD
more seronegative spondyloarthropathies in Chrons
| HLA-B27
30
symptoms of seronegative spondyloarthropathies
back pain and morning stiffness
31
exam for seronegaive spondyloarthropathies
FABER (flexion, abduction, external rotation) tests SI joint
| enthesitis
32
treatment for seronegative spondyloarthropathies
NSAIDs
MTX
surgery
33
MSK tumors derivation
mesodermal tissue
34
mets from MSK tumors
to lung
35
most common carcinomas to met to bone
```
prostate
lung
breast
thyroid
renal
```
36
bone tumors in people over age of 40
most likely metastatic
37
treatment benign soft tissue
if >5cm or deep-excision
38
treatment malignant soft tissue
resection, chemo, radiation
39
treatment benign bone
excision if aggressive
40
treatment malignant bone
chemo, resection, reconstruction, radiation
41
location of osteomyelitis
metaphysis
42
most common bacterial cause of osteomyelitis
staph aureus
| hemolytic strep, TB, syphillis, fungus, virus
43
presentation of osteomyelitis
achy, unrelenting night pain
fever
ROM is ok
swelling, warmth, redness, draining sinus
44
tests for osteomyelitis
elevated WBC with left shift
elevated inflammatory markers
Brodie's abscess
45
treatment of osteomyelitis
treatment with Vanc
surgical washout if no improvement in 2 days
may need to occur multiple times for diabetic patients
46
osteoporosis
low bone mass leading to microarchitectural deteriorization, causing increase fragility of bone
47
primary type 1 osteoporosis
postmenopausal
| caused by hormonal changes leading to bone loss
48
primary type 2 osteoporosis
senile
| caused by altered calcium metabolism leading to bone loss
49
secondary osteoporosis
```
long term steroid use
hyperparathyroidism
hyperthyroidism
renal failure
cancers
connective tissue diseases
long term immobilization
```
50
exam osteoporosis
loss of height
| thoracic kyphosis
51
T score
compared to 25 yo
52
Z score
compared to age matched peer
53
prevention of osteoporosis
maximize Ca/Vit D and weight bearing exercise before 30
| minimize smoking, caffeine, meds
54
treatment of osteoporosis
bisphosphonates
calcitonin
pulsed PTH
55
classic presentation chondrosarcoma
tooth achy pain
over 50
dots of calcification
hypocellular and bluish
56
histology of metastatic disease
epithelial (cuboidal cells)
57
radio-opaque
bones
some soft tissues
harware
58
radio-lucent
air
sutures
ligaments
59
minimum xray
2 views at 90 degrees
| xray joint above and below injury
60
most energy for fracture
comminuted fracture
61
least energy for fracture
spiral fracture
62
least tolerated leading to malunion
rotation
63
RANK pathway
RANKL on OB and marrow stroma cells
| RANK receptor on OC-allows OC generation and survival
64
M-CSF pathway
M-CSF secreted by OB
| M-CSF receptor allows OC generation and survival
65
WNT/B catenin pathway
WNT from marrow stromal cells
LRP5/6 OB receptor bind WNT protein
secrete OPG to block RANK
66
bone composition
calcium hydroxyapatite
| organic matrix mostly type 1 collagen
67
woven bone
random collagen
resists forces in all directions
pathologic in adult
rapid bone growth-healing
68
lamellar bone
ordered collagen-can be compact or spongy
replaces woven bone
stronger than woven bone
69
osteopontin
unique to bone
| levels parallel osteoblast activity
70
alkaline phosphatase
from osteoblasts
| also in liver and placenta
71
bone formation
intraamembranous ossification
direct from mesenchyme
appositional growth
72
epiphysis
distal to growth plate
73
metaphysis
beneath growth plate
74
diaphysis
center
75
dysostosis
local problems in migration of mesenchyme and their condensation
76
brachydactyly
HOXD13
77
dysplasia
global defect in regulation of skeletal organogenesis
78
cleidocranial dysplasia
short stature
abnormal clavicles
supernumery teeth
wormian bone
79
genetic cleidocranial dysplasia
RUNX2
80
achondroplasia
growth plate defect from paracrine cell defect
| reduced chondrocyte proliferation in growth plate
81
genetic achondroplasia
FGFR3 gain of function
| inhibits cartialge growth
82
bone histology in achondroplasia
growth plates are narrowed and disorganized-premature bone deposition
appositional and intramembranous bone formation continues-creates thick cortical bone
83
characteristics of achondroplasia
```
short stature
short proximal limbs
normal trunk length
enlarged head with bulging forehead
depression root of nose
```
84
most common lethal dwarfism
thanatophoric dwarfism
85
genetic thanatophoric dwarfism
FGFR3 gain of function
86
characteristics of thanatophoric dwarfism
micromelic short bowed limbs
frontal bossing with macrocephaly
small underdeveloped chest and bell shaped abdomen-respiratory failure
87
gain of function LRP5
osteopetrosis
| autosomal dominant osteopetrosis type 1
88
osteoporosis pseudoglioma syndrome
inactivate LRP5
skeletal fragility
loss of vision
89
defects in osteopetrosis
cannot acidify pit-CA2 deficiency
defect in RANKL
LRP5 gain of function
90
clinical osteopetrosis
extramedullary hematopoiesis
Erlenmeyer flask deformity
narrow neural foramina
Brittle bones
91
autosomal dominant benign osteopetrosis
```
most common
multiple fractures
anemia
hepatosplenomegaly
mild cranial nerve defects
```
92
treatment of autosomal dominant benign osteopetrosis
treated with bone marrow transplant
93
osteogenesis imperfecta
type 1 collagen disease
mutation in alpha1 or alpha2
most common is autosomal dominant
94
characteristics of osteogenesis imperfecta
```
blue sclerae
normal stature with less fractures after puberty
hearing loss from abnormal bone
joint laxity
dentinogenesis
```
95
defect in hyaline cartilage
type 2, 9, 10, 11 collagen disease
96
mucopolysaccharidoses
defect in enzymes degrading dermatan sulfate, heparan sulfate, keratan sulfate
malformed bones
defect in hyaline cartilage
97
osteopenia
decrease bone mass
98
osteoporosis
osteopenia to the point of risk of fracture
99
low turnover osteoporosis
senile
reduced osteoblasts
cortex thinned on all surfaces
mostly hereditary-vitamin D receptor, collagen 1A1, estrogen receptor
100
high turnover osteoporosis
postmenopausal
increase in inflammatory cytokines
decrease OPG increase OC
101
causes of secondary osteoporosis
```
hyperparathyroidism
neoplasia
multiple myeloma
vitamin D def
anticoagulants
corticosteroids
immobilization
```
102
test of choice for osteoporosis
dual-energy absorptiometry
103
rickets
vitamin D deficiency in children
104
osteomalacia
vitamin D deficiency in adults
105
hyperparathyroidism
PTH excess
106
renal osteodystrophy
chronic renal disease
107
most common cause of primary hyperparathyroidism
adenoma (parathyroid adenoma)
108
findings from hyperparathyroidism
loss radial aspect of middle phalanges
osteopenia
Brown tumor
109
brown tumor
bone replaced by fibrovascular tissue
| granulation tissue and hemosiderin
110
severe hyperparathyroidism
osteitis fibrous cystica
111
findings in renal osteodystrophy
hyperparathyroidism
decreased 1,25 D
metabolic acidosis due to increase release of Ca
112
most common sites for Paget
axial skeleton and proximal femur
113
osteolytic stage of Paget
loss of bone mass
| osteoclasts resorption in pits
114
mixed stage of Paget
osteolytic and osteoblastic
| prominant osteoblast and osteoclast
115
osteosclerotic stage of Paget
coarse irregular trabeculae
116
histo of Paget
mosaic pattern of lamellar bone
| jigsaw puzzle-like cement lines
117
clinical presentation Paget
```
often incidental
increase Alk Phos
normal Ca and PO4
cranial nerve palsy
heavy skull
severe secondary osteoarthritis
chalk stick-type fracture
```
118
benign tumors in paget
giant cell
119
malignant tumors in paget
osteosarcoma and fibrosarcoma
120
treatment for paget
calcitonin and bisphosphonates
121
high output cardiac failure in paget
warm skin-hypervascularity
| can create AV shunting
122
procallus-soft tissue callus
hematoma fibrin creates framework
OPG activated
no rigidity, easily disrupted
123
boney callus
woven bone
cartilage for enchondral ossification
max girth at 3 weeks
over time remodels
124
complications of fracture
misaligned bone
infected, displaced or devitalized bone leads to deformity
pseudoarthrosis from nonunion
125
osteonecrosis
infarction of bone and marrow
dead bone/fat replaced by Ca soaps
creeping substitution-slow bone growth
continued fractures and slough articular cartilage
126
most common cause of osteonecrosis
corticosteroids
127
other causes of avascualar necrosis
```
corticosteroids
idiopathic
infection
dysbarism
pregnancy
sickle cell disease
```
128
medullary infarct in avascular necrosis
geographic necrosis
| painful if large
129
subchondral infarct in avascular necrosis
chronic pain
wedge-shaped subchondral bone
tends to lead to osteoarthritis
130
bacteria reach bone in osteomyelitis
hematogenous (most common in children)
direct extension
implantation
131
cray of osteomyelitis
lytic bone lesion with surrounding sclerosis
132
pyogenic osteomyelitis in neonate
metaphysis or epiphysis
133
pyogenic osteomyelitis in child
metaphysis
| with subperiosteal abscess
134
pyogenic osteomyelitis in adult
epiphyses and subchondral bone
135
sequestrum
dead piece of bone
136
brodie abscess
small intraosseous abscess in cortex walled off by reactive bone
137
sclerosing osteomyelitis of Garre
in jaw with extensive new bone formation
138
cancer from pyogenic osteomyelitis
SCC
139
Pott disease
break through discs to other vertebrae
scoliosis and kyphosis
from TB
knees and hips second most common
140
syphilis of bone
T pallidum and T pertenue
141
congenital syphilis
to enchondral ossification centers (osteochondritis) and periosteum (periostitis)
142
acquired syphilis
bone in tertiary phase
| saddle nose, saber shin, palate, skull, vertebrae, hands/feet
143
most common benign tumors
osteochondroma
| fibrous cortical defect
144
most common malignant tumor
osteosarcoma
145
tumors of epiphysis
clear cell chondrosarcoma
| chondroblastoma
146
tumors of diaphysis
Ewing sarcoma
| fibrous dysplasia
147
tumors of epiphysis/metaphysis
giant cell tumor
| aneursymal bone cyst
148
common locations of osteoma
sinuses, skull, face
149
Gardner syndrome
multiple osteomas
intestinal polyps
epidermal cysts
fibromatosis
150
osteoid osteoma location
metaphysis
femur/tibia
humerus/hands/feet
151
xray of osteoid osteoma
central nidus
152
characteristics of osteoid osteoma
painful at night
| NSAID relief
153
common location of osteoblastoma
vertebrae posterior
154
characteristics of osteoblastoma
dull ache
| no relief from NSAID
155
most common nonhematopoetic malignant bone tumor
osteosarcoma
156
ages for osteosarcoma
early (knee)
elderly (Paget, flat and long bones)
presents as painful enlarging mass
157
most common osteosarcoma
primary, solitary, long bone (knee)
metaphysis medulla
poorly differentiated with boney matrix
158
xray of osteosarcoma
mixed lytic and blastic
breaks through cortex
Codman traingle
may have chondroid element
159
osteosarcoma metastasis sites
lungs, bones, brain
160
genetics osteosarcoma
RB
| p53 (LiFraumeni)
161
osteochondroma
mushroom shaped cartilage capped
adolescence early adult
stop growing with closure of growth plate
162
most common location of osteochondroma
long tubular bones (knee)
| metaphysis
163
genetic osteochondroma
multiple hereditary exostosis
| EXT1 or EXT2
164
chondroma
benign hyaline cartilage tumors
165
enchondroma
medullary cavity
age 20-50
nodules of hyaline cartilage with peripheral enchondral ossification
166
most common site of enchondroma
hands and feet
167
most common intraosseous cartilage tumor
enchondroma
168
subperiosteal chondroma
surface of bone
169
increased sarcoma transformation
enchondromatosis (Ollier disease)
| Maffucci syndrome-enchondromas with hemangiomas
170
xray of enchondroma
well circumscribed lucency with a thin rim of dense bone
| looks like soap bubbles
171
most common bone tumor of phalynx
enchondroma
172
most common location for chondroblastoma
knee epiphyses
| seen in teenagers
173
most common type of chondrosarcoma
conventional (hyaline and/or mixed)
174
location for chondrosarcoma
pelvis, shoulder, ribs
175
location of clear cell chondrosarcoma
long tubular bone epiphyses
| occurs in teens (along with mesenchymal)
176
x ray conventional chondrosarcoma
nodular growth with endosteal scalloping and flocculent densities from calcification
reactive thickened cortex bone
177
conventional chondrosarcoma sites of metastasis
lungs and bone
178
location of fibrous cortical defect
metaphysis of knee
| resolves into normal bone
179
location of nonossifying fibroma
metaphysis of knee
| persists
180
patterns of fibrous dysplasia
monostotic
polyostotic with soft tissue myxomas
polyostotic with endocrine dysfunction
181
xray of fibrous dysplasia
ground glass and well demarcated border
182
location fibrous dysplasia
metaphysis or diaphysis
183
locations of monostotic fibrous dysplasia
ribs, femur, tibia, jaws, calvaria and humerus
184
characteristics of McCune-Albright Syndrome
Cafe au lait skin pigmentations
endocrine-sexual precocity (often presenting)
hyperthyroidism, pituitary adenomas with GH, primary adrenal hyperplasia
185
genetic basis of fibrous dysplasia
hyperactive G protein
| GNAS gene
186
histology of fibrous dysplasia
chinese character woven bone in fibrous stroma
187
risk for fibrous dysplasia to become malignant
increased if polyostotic
| increased if irradiated
188
characteristics of ewing sarcoma
small round (blue) cell tumor
glycogen
Homer-Wright rosettes
189
genetic EWS
t(11;22) EWS-FLI1
190
EWS on xray
lytic destruction with onionskin periosteal reaction and sunburst pattern
191
giant cell tumor of bone
benign locally aggressive tumor of macrophage/monocyte system
hemosiderin
192
location of giant cell tumor
epiphyses but may extend into metaphysis
193
most common location of giant cell tumor of bone
knee
194
xray giant cell tumor
lytic excentric eroding into subchoroidal bone plate
195
aneurysmal bone cyst
multiloculated blood-filled cysts
196
location for ABC
metaphysis of long bones and vertebrae
| pain and swelling
197
xray for ABC
eccentric, expansile and well-demarcated
198
histology for ABC
blood filled cysts separated by internal septae
woven bone
fluid levels
199
most common form of skeletal malignancy
metastatic disease
200
sclerotic bone metastasis
prostate
201
cancers metastatic disease
```
prostate
kidney
breast
lung
thyroid
```
202
common location in met disease
axial skeleton
203
pediatric metastatic disease
```
neuroblastoma
Wilms tumor
osteosarcoma
Ewing sarcoma
Rhabdomyosarcoma
```
204
osteoarthritis in men
hips
205
osteoarthritis in women
knees and hands
206
primary osteoarthritis
from aging
207
secondary osteoarthritis
repeated injuries to joint
hemochromatosis
obesity
208
phases of osteoarthritis
chondrocyte injury
chondrocyte proliferation
chondrocyte drop out with loss of cartilage
209
osteophytes
extra bone at joint edge
210
characteristics of osteoarthritis
```
deep achy pain
morning stiffness
worse with use
crepitus of joint
limited range of motion
vertebral impinge on nerve roots
```
211
cysts in osteoarthritis
subchondral cysts of synovial fluid
212
joint mice
loose bodies of cartilage
213
pannus
exuberant inflamed synovium
mostly CD4 T cells, B cells, plasma cells, macrophages
granulation tissue with hemosiderin
erodes cartilage
erodes bone-juxtarticular cysts, subchondral cysts, osteoporosis
214
RF
autoAb against Fc portion or IgG (not specific)
215
more specific for RA
Ab to citrullin modified peptides (anti-cyclic citrullinated peptide)
216
synovial fluid in RA
high protein content
low mucin content
inflammation
217
clinical RA
symmetric with small joints before large
PIP, MCP
joints-warm, swollen, painful and stiff with inactivity
radial deviation of wrist, ulnar deviation of fingers
flexion-hyperextension of fingers (boutonniere)
synovial cysts-Baker cyst
218
rheumatoid nodules
most common cutaneous manifestation
found in areas subject to pressure-ulnar aspect of forearm, elbows, occiput, lumbosacral
fibrinoid necrosis surrounded by macrophages
219
vasculitis in RA
does not involve kidneys
| can be obliterative endarteritis of vasa nervorum and digital arteries
220
leukocytoclastic venulitis
purpura, skin ulcers, nail bed infarction
221
juvenile idiopathic arthritis
before 16 and present 6 weeks
oligoarticular, polyarticular, systemic
large joints
222
associated symptoms for juvenule idiopathic arthritis
pericarditis, myocarditis, pulmonary fibrosis, uveitis, glomerulonephritis, growth retardation
223
JIA differ from RA
```
oligoarthritis
systemic
large joints
no RF or nodules
may be ANA positive
```
224
JIA same as RA
pannus formation
| morphology of involved joints
225
ankylosing spondyloarthritis
HLAB27
sacroiliac joint
M>F
inflammation of tendon/ligament insertion
226
complications of ankylosing spondyloarthritis
uveitis
aortitis
amyloidosis
spine fractures
227
reactive arthritis
after infection (Chlamydia, shigella, salmonella)
triad-arthritis, urtehritis, conjunctivitis
ankles, knees, feet in asymmetric pattern
sausage toe or finger from digital tendon sheath synovitis
228
extra-articular reiter
balanitis
conjunctivitis
heart conduction defects
aortic regurgitation
229
enteritis associated arthritis
yersinia, salmonella, shigella, campylobacter
LPS stimulates response
only arthritis in knees and ankles
230
genetic psoriatic arthritis
HLA-B27 and HLA-Cw6
231
findings in psoriatic arthritis
asymmetric in DIP of hands/feet-pencil in cup deformity
can affect large joints
can cause sacroiliac and spine disease
232
extra-articular psoriatic arthritis
conjunctivitis
| iritis
233
infectious arthritis
```
bacteria always suppurative
hematogenous spread
<2 h flu
elderly and children staph
sickle salmonella
adolescent gonococcus F>M
```
234
predisposing conditions for infectious arthritis
```
immunodeficiency
abnormal joint
debilitation
IV drug use (axial joints)
arthritis
```
235
TB infectious arthritis
monarticular from adjacent osteomyelitis or hematogenous spread
vertebrae, hips, knees ankles
236
viral causes of infectious arthritis
parvo B19
HCV, HBV
HIV
237
lyme diseae infectious arthritis
2 weeks to 2 years after bit
remitting/migratory arthritis in large joints (knees>shoulders>elbows>ankles)
chronic synovitis with organisms near vessels
238
gout
uric acid from purine metabolism
| arthritis from monosodium urate
239
tophi
mass deposits of urates
| macrophages, lymphocytes, giant cells
240
negative birefringent
gout
241
primary gout
most unknown
| known enzyme defects (HGPRT)
242
secondary gout
increased nucleic acid turnover (AML)
| chronic renal disease
243
conditions for monosodium urate precipitation
lower temperatures
| lower pH
244
gout phases
asymptomatic hyperuricemia
acute arthritis (most first MTP)
intercritical gout-no symptoms
chronic tophaceous gout
245
tophaceous arthritis
inflammation destroys synovium, joint and adjacent bone
| joints and periarticular tissue
246
risk factors for primary gout
```
>30 yo
genetic predisposition
heavy drinking
obesity
drugs (thiazides)
Pb toxicity
```
247
calcium pyrophosphate crystal deposition disease
knee>wrist
usually asymptomatic
crystals first seen in articular matrix, menisci, and intervertebral disc
248
positive birefringent
CPPD
249
chalky white deposits
CPPD
250
risk factors for CPPD
hereditary
idiopathic
secondary from joint damage, hyperparathyroidism, hypothyroidism, hemochromatosis, diabetes
251
ganglion cyst
near joint or tendon sheath
cytotoxic or myxoid degeneration of tissue
no communication with joint space
252
most common site of ganglion cyst
wrist
253
synovial cyst
connected to joint capsule or bursa
254
baker cyst
popliteal synovial cyst often in setting of RA
255
genetic tenosynovial giant cell tumor
t(1;2) express CSF-1 to attract macrophages
256
tenosynovial giant cell tumor
diffuse-pigmented villonodular
localized-giant cell tumor
macrophages and giant macrophage cells
hemosiderin and lipid vacuoles
257
pigmented villonodular synovitis
```
joint synovium diffusely affected
red/born to yellow from hemosiderin
freq knee
locking or swellin
lush villous surface
```
258
localized tenosynovial giant cell tumor
often attached to synovium or tendon
| slow growing painless
259
most common soft tissue tumor of hand
localized tenosynovial giant-cell tumor
260
cubital tunnel syndrome
compression of ulnar nerve at elbow
| numbness and tingling to 4th and 5th digits
261
clinical findings for cubital tunnel syndrome
EMG shows 30% velocity reduction
262
treatment cubital tunnel syndrome
behavior modification
| surgical transposition
263
carpal tunnel syndrome
compression of median nerve at the wrist
| numbness and tingling to 1-3rd digits
264
treatment carpal tunnel syndrome
night splints, steroid injections, carpal tunnel release
265
trigger finger
inflammation of flexor tendon gets snapping through pulleys in hand
catching of finger when actively flexing finger
266
physical findings of trigger finger
palpable knot moves with tendon at distal palm
267
treatment trigger finger
NSAID
steroid injections
A1 pulley release
268
mallet finger
laceration of extensor tendon at base of DP
| inability to straighten finger tip
269
xray mallet finger
may show avulsion fracture at base of DP
270
de quervain tenosynovitis
swelling and inflammation of tendons that run through 1st dorsal compartment (APL, EPB)
pain over radial styloid
271
exam for de quervain
Finklestein's test
272
treatment for de quervain
splint, NSAIDs, steroid injection, release of compartment
273
dupuytren disease
nodular thickening of palmar fascia (N. Europeans)
painless nodules that draw 4th and 5th digits
cords may form, causing flexion of digits, table top test
274
treatment of dupuytren disease
splinting, collagenase injections, fasciotomies
275
low back pain
80% no cause
radiates to buttocks
reflexes and neuro normal
276
testing low back pain
no testing for 6 weeks unless atypical pain
xray
MRI
277
treatment low back pain
NSAIDs
no bedrest
PT
278
herniated nucleus pulposis
extrusion of center of disc posteriorly compressing nerve roots
279
site of nucleus pulposis
L4-L5
| L5-S1
280
symptoms of herniated nucleus pulposis
abrupt unilateral radicular pain, worse with activity
281
exam herniated nulceus pulposis
straight leg raise, dermatomal weakness and parasthesias
282
spondylolisthesis
forward slippage of lumbar vertebral body
| back pain when bending
283
exam spondylolisthesis
dermatomal weakness, may feel spinous process stepoff
284
tests spondylolisthesis
flex/extension xrays of spine show slippage
285
treatment spondylolisthesis
NSAID
| surgical fusion
286
spondylosis
degenerative changes in facets or discs leading to osteophytes and possible nerve compression
radicular or myelopathy may be present
287
tests spondylosis
MRI can show pinched nerves
288
treatment spondylosis
```
NSAIDs
steroids
traction
surgical decompression
fusion
```
289
C5 myotome
deltoid
290
C6 myotome
biceps, wrist extensors
291
C7 myotome
triceps, wrist flexors
292
C8 myotome
finger flexors
293
T1 myotome
interossei
294
DISH
idiopathic disease characterized by osteophyte formation spanning several vertebra
xray shows osteophytes over 4 vertebra
295
treatment DISH
NSAIDs
296
radiculopathy
compression of nerve root
unilateral radiating dermatomal pain
ROM causes radiating pain, dermatomal weakness and parasthesias, no UMN signs
297
treatment radiculopathy
NSAIDs, steroid injections, PT traction, surgical decompression
298
myelopathy
compression of spinal cord
bilateral weakness, difficulty with fine motor tasks, wide based gait
bowel and bladder dysfunction, UMN signs
299
myelopathy
epidural injections may help but surgical
300
ACL tear
primary stabilizer of knee preventing anterior tibial translation
popping sound, hemarthrosis, knee instability
50% meniscal tear
301
exam ACL tear
positive Lachman
| positive anterior drawer
302
treatment
PT for hamstring strength
| ACL reconstruction if unstable
303
frozen shoulder
idiopathic loss of shoulder motion, associated with Diabetes
early freezing
painful delt insertion
loss of 50% active and passive ROM
304
treatment frozen shoulder
NSAIDs, injections, ROM with PT
| arthroscopic lysis of adhesions and manipulation under anesthesia
305
impingement syndrome
inflammation of subacromial bursa and rotator cuff tendons in middle aged
lateral pain with overhead activity
MRI may show inflammation
306
exams impingement syndrome
positive hawkins, supraspinatous test, no weakness
307
treatment impingement syndrome
PT
steroid injection into subacromial space
surgical decompression
308
elbow epiconylitis
degenerative painful condition of the ECRB tendon and/or flexor-pronators
309
exam elbow epiconylitis
pain when resisted extension with forearm pronated (lateral) or flexion (medial)
310
treatment elbow epiconylitis
tennis elbow strap, ice, larger grips, PT, NSAIDs
steroid injection
surgical debridement
311
meniscal tear
fraying or tear of menisci
| locking and catching in the knee
312
exam meniscal tear
McMurrays positive
| joint line tenderness
313
treatment meniscal tear
PT
| arthroscopic debridement
314
olecranon bursitis
inflammation of olecranon bursa
related to gout
swelling of posterior elbow
315
test olecranon bursitis
aspiration for crystals and infection
316
treatment olecranon bursitis
NSAIDs for acute, ice
| surgical removal
317
patellofemoral pain
pain around patella without signs of arthritis, common in teenagers during growth spurt
anterior knee after sitting or climbing stairs
318
exam patellofemoral pain
Q angle
patellar apprehension
resisted extension of knee
319
treatment patellofemoral pain
PT for quad strength
320
plantar fasciitis
degenerative tear of plantar fascia, more common in women and overweight persons with tight gastroc-soleus tendons
worse in AM, insidious onset
321
exam plantar fasciitis
tender on medial and lateral calcaneous, tight dorsiflexion
322
heel spur in plantar fasciitis
not cause of pain
323
treatment plantar fasciitis
NSAIDs, heel cups, stretches of heel cord
injections
surgical release
324
rotator cuff tear
tear of supraspinatous most common, infraspinatous, subscapularis, or teres minor
acute in young, chronic in older
pain with overhead activity, catching or grating sensation
325
exam rotator cuff tear
positive drop arm, hawkins, weak supraspinatous, weak external rotation
326
treatment rotator cuff tear
PT, NSAIDs
| repair of tendons-arthroscopically or open
327
rupture of proximal biceps tendon
rupture of long head of biceps with labral injury
sudden pain, bulge in arm
pain with supination
328
treatment rupture of proximal biceps tendon
NSAID, PT
| occassionally tenodesis
329
trochanteric bursitis
inflammation of greater trochanteric bursa from tight IT bands
lateral hip pain, unable to lie on side
330
exam trochanteric bursitis
point tender over posterior GT
Ober test
MRI shows swelling of bursa
331
treatment trochanteric bursitis
NSAIDs
| PT for stretches and strengthening
332
nonunion def
failure of fracture to heal
333
open fracture def
break in overlying skin that leads to direct communications between the fractured bone and environment-leads to contamination and potential for infection
334
long bone def
femur, tibia, humerus, forearm
335
intraarticular fracture def
any fracture around joint with extension of the fracture into the joint space
336
compartment syndrome
rise of interstitial pressure within a defined space resulting n a failure of perfusion at the microvascular level causing ischemia of the myoneural tissue
-with or without fracture, in the leg, emergency
337
symptoms compartment syndrome
intractable pain with tense limb
pain out of proportion with specific and active motion
pulses and capillary refill are not an indicator of compartment syndrome
338
absolute emergencies
vascular compromise
dislocations with NV compromise
hip fractures in the young
compartment syndrome
339
relative emergencies
femur fractures
dislocations without NV compromise
pediatric elbow fractures without NV compromise (supracondylar)
340
urgencies
supracondylar elbow
geriatric hip fractures where hip replacement is treatment
tibia fracture
341
open fracture treatment
start antibiotics before leaving OR (cefazolin first line)
surgical debridement
stabilization (ex-fix or ORIF)
342
5 P of ischemia
```
pain
palor
parasthesia
pulse (less)
poikilothermia
```
343
4 C of muscle viability
color
contractility
consistency
capacity to bleed
344
scapula fracture
high energy marker
| associated injuries-rib fractures, great vessel injury, brachial plexus injury, pulm/card contusion, pneumo/hemothorax
345
clavicle fracture
risk of mal/nonunion
| surgery if severely displaced or shortened
346
humerus fracture
acute-radial nerve injury
chronic-nonunion
ORIF only if polytrauma, displaced, nonunion and NV compromise
347
forearm fracture
acute-compartment or NV compromise
| chronic-functional loss from poor reduction
348
pelvis/acetabulum fracture
marker for high energy trauma
acute-bleeding
long term-DJD, sciatic nerve/lumbar/sacral plexus
operative with displacement or instability
349
femur fracture
marker for high energy trauma
acute-cardio-pulm compromise
nonunion, pain, infection
ex fix, traction, IMN
350
tib/fib fracture
acute-open, compartment, NV compromise
chronic-mal-nonunion, osteomyelitis
stable patterns can be casted
351
low energy mechanisms
```
FOOSH
elderly hip fracture
LC-1 pelvic ring fracture falling from standing height
elbow or proximal humerus fracture
"knee fractures"
```
352
trauma evaluation
```
airway-spekaing
breathing-intubate
circulation-stable BP
disability-move extremities
expose-clothes come off
```
353
good ortho exam
palpate every join in upper and lower extremity
| rock the pelvis and check the scapula
354
distracting injury
cannot clear c-spine in fracture of extremity
355
xray in ortho trauma
gold standard
always get joint above or below fracture
joint fractures get CT and so does pelvis/acetabulum
356
xray routine in ortho trauma
```
C-spine
CXR
A/P pevis
acetabulum-judet views with rotation
pelvic ring-inlet/outlet views
```
357
pelvis fractures more dangerous
open-hemorrhage is concern
358
peroneal branch injury
posterior hip dislocations
proximal fibula
foot drop
359
tibial branch injury
knee dislocations
360
femoral nerve
antigravity muscles
damaged in penetrating trauma and iatrogenically
anterior hip dislocation
361
common patterns for abuse
unwitnessed spiral fractures
fractures prior to walking age
rib fractures-most common
femur fractures
362
suspect patterns for abuse
```
multiple posterior rib
bucket handle fractures
multiple at diff stages of healing
long spiral fractures
long bone fractures in non-ambulatory
any femur fracture
```
363
ddx with abuse
osteogenisis imperfecta
| infantile disease cortical hyperostosis (Caffey's disease)
364
fractures not usually from abuse
```
toddler fracture of tibia
torus or buckle wrist fracture
crushed fingers
nurse maids elbow
skull fracture in ambulatory child
```
365
ligament
bone to bone supporting joint
366
itis
inflammation
367
sprain
injured ligament
368
strain
muscle/tendon injury
369
passive stabilizers of shoulder
labrum (increase depth)
| glen-humeral ligament (thickening of labrum)
370
dynamic stabilizers of shoulder
involves muscle
rotator cuff
scapular rotators
371
separated shoulder
acromio-clavicular joint
| fall directly onto shoulder
372
dislocated shoulder
glen-humeral joint
| mostly anterior dislocation
373
rotator cuff tendinitis
overuse injury
| conservative treatment-rest, NSAID, rehab
374
tennis elbow
lateral wrist extensors
375
golfers elbow
medial wrist flexors
376
first degree sprain
minor
ligament intact
no laxity
mild local pain and swelling
377
second degree sprain
partial tear
some laxity
local pain, swelling and ecchymosis
378
third degree sprain
complete tear
significant laxity
ecchymosis and severe pain
repair
379
common sports injuries lower limb
intracapsular or extracapsular sprain
meniscal tear
patella-femoral pain
380
ACL injury
non-contact twisting injury
deceleration
hyperextension
pop or snap
381
meniscal tear
rotation of flexed knee to extension
medial>lateral
commonly associated with other injuries
382
high ankle sprain
syndosmotic
383
achilles tendinitis
pain in achilles tendon
occasional swelling
must rule out partial tear
384
classification of tears
longitudinal
horizontal
oblique
radial
385
scoliosis
lateral curvature
girls 7x more liekly to progress
brace at >30; surgery at >40-50
386
club foot
```
idiopathic congenital foot deformity
plantar flexion of ankle
adduction of heel
high arch
adduction of forefoot
```
387
club foot treatment
manipulation and casting immediately
| surgery if still rigid at 3 yrs
388
osgood schlatter
overuse injury causing apophyseal injury at tibilal tubercle
| xray shows fragmentation of tubercle
389
hip dysplasia
malformed hip socket and femoral head, associated with ligamentous laxity, left hip, female gender, preech
390
treatment of hip dysplasia
barlow-dislocate
| ortolani-put in
391
perthes disease
idiopathic necrosis of femoral head (between 4-8 yo)
| decreased internal rotation and abduction
392
treatment of perthes disease
ROM and bracing
| no good treatment (head blood from medial geniculate and pulvinar)
393
slipped capital femoral epiphysis
displacement of femoral head through the physis usually during growth spurt
associated with obesity, males, sports, endocrine
loss of internal rotation with hip flexed
workup for endocrine if bilateral
surgical fixation
394
treatment genu varum/valgum
observation
bracing
occassional epiphyseal stapling
osteotomy
395
tarsal coalition
abnormal connection between tarsal bones
restricted hindfoot movement
xray shows calcaneal navicular coalition
cast and surgery
396
transient synovitis of hip
sterile effusion of hip causing pain
groin pain, history of viral infection
gets better with NSAIDs
rule out septic arthritis
397
supracondylar humerus fracture
most common elbow fracture
| NV exam important
398
xray for supracondylar humerus fracture
positive posterior sail sign
399
rickets
error in vit D metabolism causing failure of mineralization
| xray shows looser lines and widened growth plates, low normal ca, phos low
400
hypertrophic zone in rickets
large
401
growth in children
lower at knee
| upper at shoulder and wrist
402
acute joint effusion
mono articular
oligoarticular
systemic-JIA, lyme, septic
403
cerebral palsy
permanent, non progressive brain injury in peripartum period
| UMN affected with spasticity
404
hemiplegia
one side
405
diplegia
both sides
| lower extremity
406
warning signs for cerebral palsy
delayed motor development
history of prematurity
prolonged NICU stay
toe walking
407
hypertrophic zone in achondroplasia
narrow
| problems with spine
408
marfan syndrome
fibrillin mutation
409
orthopaedic emergency
open fractures-tetanus and ABx, surgical debridement
410
high energy injuries
evaluate other limbs and spine for occult injuries
411
stress fractures on xray
may take 1-4 weeks to show up
412
MRI
nondisplaced femoral neck
413
fracture principles
recognition
reduce
retain
rehab
414
nonunion vs malunion
nonunion bone does not heal
| malunion-unacceptable alignment
415
primary healing
intramembranous
from rigid ifxation from plates
direct healing with no callous
416
secondary healing
enchondral
controlled motion-rods and casts
indirect formation of bone from uncommitted mesenchymal cells
417
stages of secondary healing
inflammatory
reparative for 8 weeks
remodeling for 1 year
418
risk factors for nonunion
```
lack of radiographic evidence of progression of callus formation over 3-5 month period
smoking
infection
poor immobilization
malnutrition
NSAID
poor blood supply
high energy trauma
```
419
osteogenic bone graft
bone forming
| only autologous bone graft contains viable osteoblasts
420
osteoinductive bone graft
bone stimulation
encourages differentiation of mesenchymal cells into osteoblasts
BMP2/7
421
osteoconductive bone graft
bone scaffold
| cancellous allograft
422
autografts
from pelvis
| inductive and conductive
423
allografts
only conductive and carry infection risk
424
synthetic substitutes
inductive and conductive but expensive
425
demineralized bone matrix
inductive only
426
BMPs
inductive only
427
intra-articular fracture
involves joint surface
needs perfect reduction
early motion key
428
pro casting
undisturbed fracture milleu
no incisions
heals by endochondral ossification
429
cons casting
no anatomic reduction
| stiffness
430
traction pro
does not disturb fracture
| no risk of surgey
431
traction con
poor reduction
pin site problems
fracture disease-bed sores, blood clots
432
external fix pro
load bearing
small incisions
fracture milleu ok
early motion
433
cons external fix
pin sites
434
IM pro
load bearing
small incisions
periosteal blood supply ok
stimulates endosteal blood supply
435
IM con
not anatomic
callus formation
too much movement
436
ORIF pro
anatomic reduction
load sharing
early motion
heals wit hintramembranoous ossification-undif cells become osteoclasts and lay down new osteoid
437
con ORIF
stripping increases nonunion
| bigger wounds
438
ORIF locked pro
```
load bearing
internal exfix
early mostion
less stripping of periosteum
smaller wounds
good for poor bone quality
```
439
cons ORIF locked
decreased healing due to lack of micromotion
cost
not anatomic reduction
440
weight bearing status
quicker return to function and stimulate growth bone
| but more weight than fix can handle is not good
